Fillable RESIDENTIAL ELECTRICAL APPLICATION (Clark County Board of Commission)

Fill Online, Printable, Fillable, Blank RESIDENTIAL ELECTRICAL APPLICATION (Clark County Board of Commission) Form

Use Fill to complete blank online CLARK COUNTY BOARD OF COMMISSION (OH) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

RESIDENTIAL ELECTRICAL APPLICATION (Clark County Board of Commission)

On average this form takes 8 minutes to complete

The RESIDENTIAL ELECTRICAL APPLICATION (Clark County Board of Commission) form is 1 page long and contains:

  • 0 signatures
  • 4 check-boxes
  • 29 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Clark County Board of Commission

BROWSE CLARK COUNTY BOARD OF COMMISSION (OH) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
G:\BUILDING REGS\Forms - Masters\Applications\Updated Forms 11/6/19
RESIDENTIAL ELECTRICAL APPLICATION
PLEASE PRINT OR TYPE APPLICATION NO:_______________
PLEASE SEE SUBMITTAL REQUIREMENTS PART B
OFFICE USE ONLY
ELECTRICAL PERMIT FEES
Application Fee …………………………………………….$40
Services
100amp or less………………………………………….…$5
101-200………………………………………………………..$6
201-400………………………………………………………..$7
401-600…………………………………………………….…..$8
601 and over……………………………………………….$10
Swimming Pool Bonding....…………………………….$5
Temporary Pole………………………………………………$5
Field Inspection………$45 x______ =_________
Plan Review Fee……………………….………………….$20
Work Without Permit…………………………………$200
SUBTOTAL _________
1% OBBS State Assessment Fee __________
TOTAL ELECTRICAL PERMIT FEE __________
1. PROJECT INFORMATION
What City, Village, or Township is this project located in?____________________
Project Address______________________________________________________
City/State/Zip Code___________________________________________________
Project Description/Size of Service
___________________________________________________________________
This project is:
Part of other New Construction, Alterations, or Change of Use
Electrical drawings included with building plans
A stand-alone New Work Project, Addition, Upgrade or Repair
Power for this property will be supplied by
Ohio Edison
DP & L
South Vienna
Pioneer
Ohio Edison Notification #_____________________________________
2. PROPERTY OWNER
Name______________________________________________________________
Phone_____________________________________________________________
Address____________________________________________________________
City, State, Zip Code__________________________________________________
3. ELECTRICAL CONTRACTOR
Contact Person______________________________________________________
Cell Phone__________________________________________________________
Company Name______________________________________________________
Address____________________________________________________________
City, State, Zip Code__________________________________________________
Phone_______________________ Fax___________________________________
E-Mail_____________________________________________________________
OFFICE USE ONLY
Received:
Counter
Mail
Fax
E-mail
Date__________Intake Person______________
Plans Reviewed by _________Date___________
Plans Approved by__________Date___________
Notified Permit ready by _______Date__________
Paid ____________ Date ___________________
4. APPLICANT
Contact Person______________________________________________________
Company Name_____________________________________________________
Address____________________________________________________________
City, State, Zip Code__________________________________________________
Phone____________________________ Fax______________________________
E-Mail_____________________________________________________________
I hereby certify that I am the Owner of Record, that I have been authorized by the
Owner to make this application as his Agent, and that we agree to conform to ALL
laws of the County and the State, and that all information on this application is
truthful to the best of my knowledge. I also understand that UPFRONT FEES ARE
NON-REFUNDABLE AND NONTRANSFERABLE.
Applicant Signature____________________________Date___________
RESIDENTIAL ELECTRICAL PLAN SUBMITTAL FORM Part B
General Instructions
• The plan submittal form must be filled out completely.
• The application may be faxed or e-mailed to our office at anytime. Once the application is approved
the staff will call the applicant indicating approval and total cost of permit. It is the applicant’s
responsibility to check periodically on the status of this application.
• All work shall conform to the 2014 National Electrical Code.
Submittal Requirements
1. Submit a one-line drawing complete from the point of service delivery from the utility, showing the
size and type of all service conductors, grounding conductors, raceways, feeders and all panels and
sub-panels.
2. Indicate the temperature rating of lugs if conductor size is based on ratings greater than 75°C.
3. Provide panel schedule if adding new circuits.
For more information or questions:
Clark County Community & Economic Development
Springview Government Center
3130 E. Main Street, Suite 1A
Springfield, OH 45505 General E-mail: communitydevelopment@clarkcountyohio.gov
(937) 521-2160 Website: www.clarkcountyohio.gov/communitydevelopment
(937) 328-2621 fax
Office Hours
Monday through Friday
Office opens at 7:30 am
Front Counter closes at 4:00 pm
Office closed at 4:30 pm
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

RESIDENTIAL ELECTRICAL APPLICATION (Clark County Board of Commission)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 17 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document